Methods and systems for electrode placement

ABSTRACT

Described herein are systems, devices and methods for guiding placement of electrodes, and particularly ECG electrodes on a patient. A picture of the patient&#39;s body the patient can be analyzed to determine where on the patient&#39;s body to place electrodes according to a predetermined, conventional or standard placement pattern. The methods, devices and systems may then guide a user in positioning or correcting the position of electrodes on the patient. For example, an image of the patient may be provided showing the correct position of the electrodes, which may act as a patient-specific map or guide. The electrode placement positions can correspond to conventional or standard 12-lead ECG electrode positions.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.14/948,026, filed Nov. 20, 2015, titled “METHODS AND SYSTEMS FORELECTRODE PLACEMENT”, which is a continuation application of U.S. patentapplication Ser. No. 14/149,242 filed Jan. 7, 2014, which claimspriority to U.S. Provisional Patent Application No. 61/749,790, titled“METHODS AND SYSTEMS FOR ELECTRODE PLACEMENT,” filed on Jan. 7, 2013.

This patent application may be related to U.S. patent application Ser.No. 13/964,490, titled “HEART MONITORING SYSTEM USABLE WITH A SMARTPHONEOR COMPUTER,” filed Aug. 12, 2013, which is a continuation of U.S. Pat.No. 8,509,882, titled “HEART MONITORING SYSTEM USABLE WITH A SMARTPHONEOR COMPUTER,” filed on Jun. 8, 2010, and to U.S. patent application Ser.No. 13/108,738, titled “WIRELESS, ULTRASONIC PERSONAL HEALTH MONITORINGSYSTEM,” filed on May 16, 2011, and published as US-2011-0301439, eachof which is herein incorporated by reference in its entirety.

INCORPORATION BY REFERENCE

All publications and patent applications mentioned in this specificationare herein incorporated by reference to the same extent as if eachindividual publication or patent application was specifically andindividually indicated to be incorporated by reference.

FIELD

This patent application discloses inventive concepts related generallyto guiding, correcting, and/or improving the placement of electrodes ona subject/patient.

BACKGROUND

Electrical measurement of biological activity, and particularlynon-invasive electrical measurement, is increasingly important inmedical therapy, diagnostics, and research. For example, electrodes ofvarious types may be used to record electrocardiograms (ECGs),electroencephalograms (EEG), electromyogram (EMG), galvanic skin reflex(GSR), electrooculogram (EOG), bioimpedance (BI), and others, includinginvasive or implantable measurements. Accurate and reliable electricalmeasurements from patients may require precise or consistent placementof the electrodes used for measurement on the patient's body, which mayrequire that the user placing the electrodes have a great deal oftraining and experience. The consequences of placing the electrodesoutside of the predetermined, conventional, or standard locations on thebody may result in inaccurate results.

For example electrocardiography is used to examine and monitor theelectrical activity of the heart. ECGs are increasingly valuable toolsfor treating patients at risk for heart disorders. Electrocardiograms(ECG) can be recorded or taken using multiple electrodes placed on theskin of a patient, and electrical signals recorded between twoelectrodes may be referred to as leads. A variety of different leadpatterns, including different numbers of electrodes, may be used to takean ECG. For example, an ECG may be taken with 3, 5, and 12 leads. For astandard 12-lead ECG, 10 electrode positions are typically used: six onthe chest, and one on each of the patient's arms and legs.

The placement of the electrodes for the ECG is important. Despite thecommon use of ECGs within the medical profession, it is not uncommon forelectrodes to be incorrectly placed on the patient by the nurse, medicaltechnician, or physician. Incorrect placement of electrodes canadversely affect the ECG results and make comparison of the ECG resultsto standard ECG data difficult. Because of this sensitivity, theplacement of leads is typically left to trained medical technicians(e.g., ECG technicians), as it is difficult for an untrained user tocorrectly place electrodes; it would be particularly difficult for anuntrained user to correctly place leads on their own body. As mentioned,placing one or more of the electrodes used to measure an ECG outside ofthe accepted (standard or conventional) positions on the patient's bodycan affect the ECG, making it difficult to compare to a standard ECG andtherefore difficult for a medical professional to interpret.

Electrodes are typically placed on a patient by a human, allowing anopportunity for human error to result in incorrect electrode placement.The methods, devices and systems disclosed herein can be used to improveguide the electrode placement on a patient. Accurate electrode placementcan result in improved patient data (e.g., ECG data), better patientdiagnosis and treatment, and improved patient health. Although attemptshave been made to minimize the error introduced by varying electrodeplacement in ECG systems, including creating systems that are supposedto tolerate a greater variability in ECG measurement, these efforts havehad limited success. For example, U.S. Pat. No. 6,282,440 describesmethods for calculating and determining whether electrodes are in thestandard ECG electrode placement, an alternative electrode placement, oran incorrect electrode placement based on an analysis of the ECGmeasurements resulting from electrode placement. Unfortunately, U.S.Pat. No. 6,282,440 does not provide a method for guiding the initialplacement of electrodes or easily correcting incorrect measurements.

Different configurations for ECG electrode placement may be used on apatient. Common, customary or standard positions for these ten electrodepositions have been determined for use in taking a 12-lead ECG.Measurement taken from ten (10) electrode positions on a patient may beused to produce a standard 12-lead electrocardiogram (ECG).

Thus, a standard or conventional 12-lead ECG configuration typicallyuses 10 electrode positions, which may mean the placement of tenseparate electrodes in these positions. FIG. 1 illustrates placement of10 electrodes that may be used for a 12-lead ECG, with 6 electrodes onthe patient's chest and one electrode on each of the patient's arms andlegs. The electrode placed on the right arm is typically referred to asRA. The electrode placed on the left arm is referred to as LA. The RAand LA electrodes are placed at approximately the same location on theleft and right arms, preferably near the wrist. The leg electrodes canbe referred to as RL for the right leg and LL for the left leg. The RLand LL electrodes are placed on the same location for the left and rightlegs, preferably near the ankle. In practice placement of the arm andleg electrodes is much less challenging than placement of the electrodeson the patient's chest. Further, ECG measurements may be more sensitiveto variations in the placement of chest electrodes.

FIG. 2 illustrates standard placement positions of the six electrodepositions on the chest, labeled V₁, V₂, V₃, V₄, V₅, and V₆. For astandard 12-lead ECG measurement, V₁ is typically placed in the fourthintercostal space, for example between ribs 4 and 5, just to the rightof the sternum. V₂ is placed in the fourth intercostal space, forexample between ribs 4 and 5, just to the left of the sternum. V₃ isplaced between electrodes V₂ and V₄. V₄ is placed in the fifthintercostal space between ribs 5 and 6 in the mid-clavicular line. V₅ isplaced horizontally even with V₄ in the left anterior axillary line. V₆is placed horizontally even with V₄ and V₅ in the mid-axillary line.Electrodes are also typically positioned on the patient's right and leftarm and right and left leg. This arrangement of electrode positions,including the positions on arms and legs, may be referred to as standardor conventional 12-lead ECG electrode positions.

Based on measurements between these electrode positions, standard “lead”measurements may be taken. For example, lead I is the voltage betweenthe left arm (LA) and right arm (RA), e.g. I=LA−RA. Lead II is thevoltage between the left leg (LL) and right arm (RA), e.g. II=LL−RA.Lead III is the voltage between the left leg (LL) and left arm (LA),e.g. III=LL−LA. Wilson's central terminal (WCT or V_(w)) can becalculated by (RA+LA+LL)/3. Augmented limb leads can also be determinedfrom RA, RL, LL, and LA. The augmented vector right (aVR) is equal toRA−(LA+LL)/2 or −(I+II)/2. The augmented vector left (aVL) is equal toLA−(RA+LL)/2 or I−II/2. The augmented vector foot (aVF) is equal toLL−(RA+LA)/2 or II−I/2. Leads I, II, III, aVR, aVL, and aVF can all berepresented on a hexaxial system illustrated in FIG. 3. Incorrect orshifted electrode placement can shift the results of the ECG on thehexaxial system.

The signals from this 12-lead system may be used to examine theelectrical signal resulting from cardiac activity. The 12-leadmeasurements have been accepted as providing medically relevantinformation about cardiac health. FIG. 4 illustrates a sample ECGannotated to show characteristic features used for analysis of cardiacfunction, in particular PQRST waves. Identification and measurement ofthe PQRST waves across the 12 leads is well accepted as providingrelevant information about the health of a patient. For example, FIG. 5illustrates data collected from a patient using a 12-lead standardconfiguration. The data can be analyzed to obtain representations of thePQRST waves for this patient. As mentioned, incorrect placement of theelectrodes changes the measured values for the leads.

There may be multiple acceptable positions (or ranges of positions) forelectrodes, including ECG electrodes. For example, FIGS. 6A and 6B showdifferent configurations for the arm and leg electrodes that may be usedin an ECG. The RA/LA electrodes may be placed near the wrist, as shownin FIG. 6A, or near the shoulder, as shown in FIG. 6B, and the RL/LLelectrodes may be placed near the ankle (FIG. 6A) or near the pelvis(FIG. 6B). Positioning the arm electrodes near the wrist and the legelectrodes near the ankles as shown in FIG. 6A is widely accepted as astandard or conventional electrode configuration for the arm and legelectrodes in a 12-lead ECG. Alternatively, positioning the arm and legelectrodes adjacent to the thorax as shown in FIG. 6B may be referred toas the Mason-Likar system for electrode placement. The Mason-Likarsystem is often used to take an ECG during exercise because the arm andleg electrodes are positioned closer to the chest and torso and placedin areas of the body that move less during exercise. The electrodepositioning differences between the standard configuration and theMason-Likar system can result in differences in the ECG signalsreceived, since the relative positioning of the arm electrodes affectsthe measured leads (see, e.g., “Resting 12-Lead ECG Electrode Placementand Associated Problems” by Macfarlane et al., SCST Update 1995).

Thus, it would be beneficial to provide improved methods for accuratelyplacing electrodes on the body of a patient.

SUMMARY OF THE DISCLOSURE

In general, described herein are methods, devices and systems forguiding and/or correcting placement of electrodes on a patient. Thesemethods may be particularly useful for guiding placement of electrodesfor ECG measurements. In general, the systems, devices and methodsdescribed herein process a picture of a patient to output electrodepositions on the patient. Typically this may include presenting an imageof the patient (e.g., a modified version of the picture of the patient)showing the locations for the electrodes relative to the actual patientpicture.

For example, a system or device for guiding electrode placement asdescribed herein may include control logic for controlling a processor(e.g., microprocessor of a computing device such as a hand-heldcomputing device) to receive a picture of a patient, to analyze thepatient to determine the correct placement of the electrodes, and tooutput an image of the patient on which the correct predeterminedelectrode positions have been marked. In general, the control logic maybe configured as software, hardware or firmware, and may control ageneral-purpose computing device (e.g., computer, tablet, or the like)or a mobile telecommunications device (smartphone, such as iphone™,android™, etc.) to accept or acquire the picture and output the image ofthe patient. The processing step may be performed remotely or locally.In general, the processing step may include comparing the picture of thepatient to a database (e.g., an electrode placement database) of variousbody types and corresponding predetermined, conventional or standardpositions for electrodes associated with each body type. The picture ofthe patient may also be normalized prior to comparing the picture thepatient database by adjusting the size, and/or in some cases the aspectratio, brightness, contrast, or other image features, of the picture toallow direct comparison with the database. Normalization may beperformed using a marker included as a part of the picture. For example,the picture of the patient may be taken with a marker of known orknowable size on the patient, and the marker may be used as anormalization marker to normalize the picture before comparison with thedatabase. Normalization may also be performed to even out thebrightness, contrast, sharpness, or other imaging quality of thepicture. The marker may be placed or applied directly onto the patient(e.g., the patient's torso), e.g., by adhesive, etc.)

Also described herein are methods performed by the devices and systemsfor guiding electrode placement, such as methods of guiding electrodeplacement on a patient.

For example, described herein are methods for guiding proper placementof electrodes on a patient that include: comparing a picture of thepatient to an electrode placement database to determine positioning ofelectrodes on the patient, wherein the electrode placement databasecomprises representations of a plurality of body types and predeterminedelectrode placement positions corresponding to each body type; andpresenting an image of the patient showing positions for electrodes onthe image of the patient.

These methods may be particularly adapted for guiding placement of ECGelectrodes on a patient in a standard or conventional configuration onthe patient. Thus, the database may be configured to include a pluralityof body types with corresponding conventional/standard electrodeplacement positions for each body type in the database.

In some variations electrode positions may be determined and indicatedfor all of the electrodes (e.g., all 10 electrode positions used for astandard 12 electrode lead). However, in some variations on a subset ofthe electrode positions may be determined and/or displayed. For example,a method of guiding positioning of a standard/conventional 12-leadelectrode placement may determine and show only the six electrodepositions on the patient's chest. In some variations where otherelectrode positions may be determined relative to one or more keyelectrode positions, only the position of the key electrode(s) may beshown.

In general, any appropriate picture of the subject may be used. In somevariations, the system, devices or methods may include taking oracquiring the picture. As described in greater detail below, in somevariations the picture may be taken by the system or device performingthe method (e.g., a smartphone or other handheld computer device). Thesystems, devices and methods described herein may instruct a user how totake the picture of the patient, including positioning the patient(facing forward, standing, sitting, lying, etc.), approximately how farfrom the patient to take the picture, positioning a normalization markeron or near the patient, and the like. The picture may be received as adigital image. The picture may include an image of the patient, andparticularly a region of the patient's body to which the electrodes areto be applied. For example, when applying ECG electrodes, the picturemay include the patient's torso or chest. Additional regions of thepatient's body may be included, such as the patient's head, legs, etc.The patient may be standing, seated or lying down. The region of thepatient to which the electrodes will be applied is typically bare (e.g.,a may be shirtless or at least partially shirtless, so that the skin canbe visualized). As mentioned, in some variations a normalization markermay be included as part of the picture. For example, a reference markermay be placed on the patient; the reference/normalization markertypically has a known or standard size, such as a coin (e.g., a U.S.quarter, penny, etc.). In some variations the reference marker isprovided, and may be a distinct shape or color. In some variations themarker is automatically recognized by the apparatus. For example, themarker may include a readable code (e.g. bar code, alphanumeric code, QRcode, etc.); alternatively the apparatus may identify the marker bycolor, shape, etc.

In variations in which the method, system or device guides the userthrough taking or acquiring the picture, the picture may be qualified bythe system or device. Qualifying the picture may include checking thepicture to confirm that it is suitable and can be analyzed (e.g.,compared) to the database.

As used herein the phrase “patient” is intended broadly to include anysubject on whom the methods, devices and systems may be used to helpposition electrodes. A patient may include an animal (in systems anddevices specifically configured for use with that type of animal) orhuman, and may include healthy or non-healthy subjects. As used herein a“user” may be a person using the systems, methods and devices asdescribed herein. In some variations the user is the same as thepatient, as the systems, devices and methods described herein may beused by a patient to guide placement of electrodes on his or herself.

In some variations, comparing the picture to the electrode placementdatabase may comprise determining the standard placement of electrodesfor a 12-lead ECG on the patient.

In general, comparing the picture of the patient to the electrodeplacement database may include determining a match (e.g., the closestmatch) between the picture and one or more representative body types inthe patient database. Once one or more closely matching representativebody types have been identified, the electrode placement correspondingto the representative body types for the match(s) may be mapped to thepicture of the patient. Where more than one match is identified,electrode placement may be determined from the standard electrodesplacements corresponding to the multiple representative body matches byweighting, averaging, or other appropriate statistical method forfinding a consensus standard among the closest matches, and mapping thisstandard electrode placement to the picture of the patient.

As described in greater detail below, an electrode placement databasetypically includes a plurality (e.g., >10, >100, >1000, >10,000, etc.)of representations of standard/conventional electrode placement fordifferent bodies. A representation of a body type may include an imageof a body (e.g., picture, portion of a picture, etc.) or informationextracted from an image of a body including electrode placement specificfor that body, where the electrode placement has been confirmed orverified as within the standard/conventional bounds. The various bodytypes may include body types of different shapes and sizes (height,weight, morphology), gender (male/female), age (infant, child, adult,elderly), physical morphology (shoulder width, chest size, waist size,etc.), and the like. Each body type representation may be unique,although similar body types may be included, creating clusters of bodytypes around more common body types. All of the body types in thedatabase may be pre-normalized to allow comparison between the differentrepresentations. Multiple different electrode placement databases may beused. For example, separate databases may be used for different patientpositions (lying, sitting, standing, etc.), or for different patientgenders, ages, etc. Further, different electrode placement databases maybe used for different standard/conventional electrode placements.

Thus, in addition to normalizing the picture before comparing it to anelectrode placement database, the picture may be processed to prepare itfor comparison with the database. In variations in which the comparisonis made by extracting features from the picture and comparing theseextracted features to the representations of body types in the database,the extraction of features may be performed on the picture before (or aspart of) the comparison. For example, when comparing the picture of thepatient to the electrode placement database includes determininganatomical landmarks from the picture and comparing the anatomicallandmarks to the electrode placement database, anatomical landmarks maybe extracted from the picture first. The picture may also be processedto remove patient-identifying features (e.g., all or part of thepatients face, etc.) which may be relevant to protect patient privacy.

As mentioned above, the comparison of the picture with the database maycomprises interpolating between the closest matches to the picture andtwo or more representative body types in the patient database.

In some variations, comparing the picture of the patient to the databasecomprises using pattern recognition to determine the closest matchbetween the picture and a representative body type in the database. Insome variations, comparing the picture of the patient to the electrodeplacement database comprises comparing the normalized picture of thepatient to the electrode placement database.

The methods, devices and systems described herein may also includepresenting the image of the patient showing positions for electrodes onthe image of the patient. Any appropriate image of the patient may bepresented, including a modified version of the picture of the patientshowing the positions of the electrodes determined by comparison withthe database. In some variations, the image of the patient is digitallydisplayed (e.g., on the handheld computing device). And may be enlarged(zoom in/out) or manipulated so that the user can see where to place theelectrodes. In some variations the image may include additionalguidelines, including measurements (rulers, distances in inches, mm,etc.) relative to the patient, including patient landmarks, such asanatomical landmarks, and/or relative to other electrodes.

The presentation of the image of the patient showing theconventional/standard position of the electrodes may show all of theelectrodes, or some of the electrodes. In some variations, thepresentation of the image may include a series of images separatelyshowing the patient with different electrode positions indicated, tobetter allow a user to step through the process of applying orrepositioning the electrodes. In general, the presentation of the imageof the patient may be visual (showing the image) and may also includetextual (written/spoken) instructions for applying the electrodes. Forexample, in variations of the systems and methods described hereinintended for use with a handheld computer device, such as a smartphone,the device may controlled to step the user through both taking thepatient's picture and positioning (or repositioning) the electrodes bylooking at the screen of the smartphone.

In some variations, the methods, devices and systems described hereinmay be used to correct and/or verify the position of electrodes alreadypresent on a patient. For example, the user may take or receive apicture of a patient with ECG electrodes already on the chest. Comparingthe picture of the patient to the electrode-placement database may alsocompare the position of the electrodes already on the patient with thedetermined standard/conventional positions. Thus, comparing the pictureof the patient to an electrode placement database may comprise comparinga picture of the patient having one or more electrodes already placed onthe patient's chest to the electrode placement database. The position ofthe one or more electrodes already placed on the patient's chest maythen be verified either automatically (indicating when one or more isincurred) or passively by overlying the correct positions (indicated insome specific way, e.g., by a color) onto the picture of the patient toform the presented image. In some variations the image presentedincludes an image of the patient showing corrected positioning ofelectrodes on the image of the patient.

Also described herein are methods for guiding placement of ECGelectrodes that include: receiving a picture of a patient including thepatient's chest; comparing the picture of the patient to an electrodeplacement database to determine positioning of electrodes on thepatient, wherein the electrode placement database comprisesrepresentations of a plurality of body types and predeterminedconventional ECG electrode placement positions corresponding to eachbody type; and presenting an image of the patient showing positions forconventional ECG electrode positions on the image of the patient. Themethod, wherein comparing the picture of the patient to the electrodeplacement database includes determining the closest match between thepicture and a representative body type in the electrode placementdatabase.

As mentioned above, comparing the picture of the patient to theelectrode placement database includes determining anatomical landmarksfrom the picture and comparing the anatomical landmarks to the electrodeplacement database. In some variations, comparing the picture of thepatient to the database comprises using pattern recognition to determinethe closest match between the picture and a representative body type inthe electrode placement database.

In any of the variations described herein, the comparing of the patientpicture with the electrode placement database may be performed remotelyfrom the other steps. For example, a smartphone may be used (e.g., usingan application downloaded to the phone) to acquire the picture of thepatient, and to present the image of the patient showing theconventional positions of the electrodes; the comparison of the picturewith the database may be performed remotely, using a remote server.Thus, the database may be maintained separately from the application onthe smartphone (or other device). This may allow modification, updating,or otherwise amending the database and/or the mechanisms for comparingthe picture of the patient to the database. The image generated may thenbe presented on a handheld computer device after it receives information(or the generated image) back from the remote database. Alternatively,in some variations all of the steps are performed on the local level(e.g., using the handheld computing device, such as a smartphone ortablet computer).

As mentioned above, the picture of the patient may include anormalization marker. Thus the step of receiving the picture of apatient may include receiving a picture of a patient includes anormalization marker. In some variations, the picture of the patientreceived may include electrodes on the patient's chest; the method,device or system may verify the placement of the electrodes already onthe chest relative to conventional ECG electrode placement positions.

Also described herein are methods for determining the placement of ECGelectrodes including: receiving a picture showing a patient includingand a normalization marker; normalizing the picture using thenormalization marker; comparing the normalized picture to an electrodeplacement database comprising representations of a plurality of bodytypes and predetermined ECG electrode placement positions for each bodytype to determine positioning of electrodes on the patient; andpresenting an image of the patient showing positions for ECG electrodeson the image of the patient.

A system or device may be configured to perform any or all of the stepsdescribed above for receiving a picture of a patient including theregion of the patient to which electrodes are to be applied, analyzingthe picture, and providing an image of the patient (or any otherpatient-specific map) showing the location(s) of one or more electrodeson the patient based on predetermined, conventional and/or standardelectrode positions.

Although many of the examples described herein are specific to systems,devices and methods of placing ECG electrodes according to standard orconvention 12-lead ECG electrode placement, these systems, devices andmethods may be used (or adapted for use) with any predetermined,conventional and/or standard electrode positioning system, includingelectrodes for electroencephalograms (EEG), electromyogram (EMG),galvanic skin reflex (GSR), electrooculogram (EOG), bioimpedance (BI),etc. For example, the electrode placement database may include a varietyof body types and corresponding predetermined, conventional and/orstandard electrode positions for each of the body types for EEG, EMG,GSR, EOG, BI, etc. In some variations, the different electrode placementregimes (different conventional and/or standard electrode placement) maybe linked in the database to each body type, and a user may select whichplacement regime to display. In other variations, more than oneplacement regime may be shown, either sequentially or simultaneously,for the same patient. For example, for ECG electrode placement, theelectrode placement can correspond to 3-lead, 5-lead, and 12-lead ECGs.

A system for guiding electrode placement may generally include controllogic, which may be executed as software, hardware, or firmware (orcombinations thereof) that receive the picture of the patient, determineconventional and/or standard electrode placement for that patient usingan electrode placement database, and output a map or image of thepatient showing where on the patient the electrodes should bepositioned. The system may also be configured to guide or walk the userthrough the process of taking the picture of the patient and/orpositioning the electrodes on the patient. In some variations, thesystem is configured to guide the user by audible instructions, writteninstructions and/or visual instructions. The system may be configured towork from (e.g., control) a handheld computing device, including asmartphone (e.g., iPHONE, ANDROID, etc.) to receive (and in some casestake) the picture of the patient and output the image of the patientwith the determined electrode position(s) marked. For example, thesystem may be configured as an application for a smartphone that isdownloadable onto the smartphone.

Any of the systems described herein may be dedicated systems that comepre-configured to receive a patient picture and output an image of thepatient showing electrode placement positions, and do not requiredownloading of an application (e.g., software) onto a separate device.For example, a system may include a camera for taking a picture of thepatient, control logic for receiving the picture, controlling analysisof the picture to determine electrode placement using an electrodeplacement database, and outputting a map or image of the patient showingthe location of one or more electrodes according to a conventionaland/or standard electrode positioning regime. The system may include allor a portion of the electrode placement database, or the system maycommunicate with a remote electrode placement database. Further, thesystem may include a comparison unit, which may include comparison logicfor comparing the picture of the patient with the body types in theelectrode placement database in order to find one or more close matchesbetween the patient and the body types in the database, from which thepredetermined conventional and/or standard electrode positions can beextrapolated to the patient picture.

The system may also be configured to use (and may include as part of thesystem) a normalization marker that is included in the picture of thepatient. A normalization marker is typically a distinct maker that thesystems/devices described herein may distinguish in the picture, andwhich may be used to provide scale and/or orientation for reference inthe picture. For example, the normalization marker may be a sticker thatcan be attached to the skin of the patient; the sticker may be brightlycolored, and may have a known size (e.g., an orange circle of one inchdiameter). The system/device can therefore distinguish this sizingmarker in the picture, and can normalize the picture using thenormalization marker. In some variations the normalization marker mayalso provide a reference position which the system may use in providinginstructions for placement of the electrode(s). In some variation morethan one sizing maker may be used. A normalization marker may be acommon object of known dimension, such as a coin. The user may indicatein the system/device what the normalization marker (e.g., from a menu ofpossible normalization markers).

As mentioned, the image of the patient showing positioning of electrodescan be presented to the user on a handheld computer device. For example,the handheld computer device can be a mobile phone, smartphone, tabletcomputer, or camera with network connectivity.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a pictorial representation of a body showing an example ofelectrode placement for taking an ECG.

FIG. 2 shows a semi-transparent image of a chest showing one example ofelectrode placement on the chest for taking an ECG, according to aportion of a conventional 12-lead ECG electrode placement (electrodepositions on the arms and legs are not shown).

FIG. 3 shows a hexaxial reference system for an ECG.

FIG. 4 shows an exemplary ECG trace illustrating the PQRST wave.

FIG. 5 shows a sample 12-lead ECG for a patient.

FIGS. 6A and 6B show conventional/standard and Mason-Likar arm and legelectrode placements respectively, for ECG electrode placement.

FIG. 7A shows one example of a picture of a patient onto whichelectrodes may be placed for a standard ECG electrode placement.

FIG. 7B shows an image of the patient from the picture of FIG. 7A ontowhich positions for six ECG electrodes have been marked as describedherein.

FIG. 8A shows a picture of a patient on whom six electrodes have alreadybeen placed.

FIG. 8B shows an image of the patient (including the six electrodes)from FIG. 8A, onto which corrected positions for the six ECG electrodeshave been marked.

FIG. 9 illustrates exemplary representations of a plurality of bodytypes and predetermined electrode placement positions corresponding toeach body type forming part of one variation of an electrode placementdatabase.

FIG. 10 is an exemplary flowchart describing a method for guiding theplacement of electrodes on a patient in accordance with one embodiment.

FIG. 11 is an exemplary flowchart describing a method for providing auser with guidance for placing electrodes in accordance with oneembodiment.

FIG. 12 is an exemplary flowchart of a method for determining theplacement of electrodes on a patient in accordance with one embodiment.

FIG. 13 illustrates one example of a system for guiding electrodeplacement.

DETAILED DESCRIPTION

In general, described herein are systems, devices and methods fordetermining the placement of electrodes on a patient. In general, thesesystem, devices and methods operate by receiving a picture of apatient's body, and comparing the picture to a database withrepresentations of a plurality of different body types, in order to findthe closest match or matches between the patient picture and thedifferent body types. The database may be referred to as an electrodeplacement database, and typically includes representations of a varietyof different body types and, for each body type, associatedpredetermined electrode placement positions for each of the body types.The predetermined electrode placement positions may correspond toconventional and/or standard electrode positions, which may have beenpreviously verified. These systems, devices, and/or methods may thenextrapolate the optimal placement of one or more electrode(s) on thepicture of the patient based on the one or more matches from thedatabase, and present a map of this optimal placement. The map may be animage that includes the picture of the patient on whom the optimalposition(s) (or a range of positions) have been drawn. These systems maybe referred to as systems for guiding electrode placement (or electrodeplacement systems); similarly the devices may be referred to as devicesfor guiding electrode placement or electrode placement devices; and themethods may be referred to as methods for guiding electrode placement.These systems, devices and methods may be particularly helpful forassisting, confirming or guiding placement of ECG electrodes, e.g., forperforming “standard” 12-lead ECG measurements.

Any of the systems described herein may be configured for operation witha handheld computing device, and particularly a smartphone device suchas an ANDROID or iPHONE. Thus, the steps of receiving the picture of thepatient, and/or presenting the image showing electrode locations may beperformed by a handheld computer device. Thus, in some variations thesystems described herein generally include control logic for directingthe handheld computing device to perform the steps of acquiring thepicture of the patient, analyzing the picture using the database, andpresenting the image of the patient. The control logic may also includeadditional steps, at least some of which may be optional, includingguiding a user to acquire the picture of the patient, using anormalization marker (which in some variations may be referred to as asizing marker), normalizing the picture, passing the picture to ananalysis unit for accessing an electrode placement database andcomparing the picture to the database, extrapolating the optimalelectrode placement for the patient from the database, and generating aplacement map (e.g., image) for the patient. The control logic may alsopresent the placement map.

For example, the methods, systems and devices described herein may beused to determine the optimal placement of electrodes for performing 12lead ECG recordings from a patient by receiving a picture of a patient'sbody showing the patient's chest and outputting an image of the patientshowing optimal positions for at least some of the electrodes on animage of the patient. Thus, the determined electrode positions cancorrespond to conventional lead positioning for electrodes in an ECG ina 12-Lead ECG, and may be used to position electrodes in the properpositions on the patient's actual (rather than virtual) chest.

Examples and illustrations of these methods, devices and systems areprovided herein, however the inventions described herein are not limitedin application to the specific details of construction, experiments,exemplary data, and/or the arrangement of the components set forth.Other embodiments or variations for practicing or carrying out theseinventions are expressly contemplated. The terminology employed hereinis for purpose of description and should not be regarded as limiting,unless specifically indicated as such. Thus, in the following detaileddescription of embodiments of the disclosure, numerous specific detailsare set forth in order to provide a more thorough understanding of thedisclosure. However, it will be apparent to one of ordinary skill in theart that the concepts within the disclosure can be practiced withoutthese specific details. In other instances, well-known features have notbeen described in detail to avoid unnecessarily complicating thedescription.

As illustrated in FIG. 10, a method of guiding electrode placement mayinclude comparing a picture of a patient to an electrode placementdatabase that includes a plurality of predetermined, conventional and/orstandard electrode placement positions for a variety of different bodytypes 1072. The patient picture is compared to the variety of differentbody types to determine the closest match(s). The correspondingelectrode placement positions on the one or more closest matches maythen be used to extrapolate the conventional/standard electrodeplacement on the patient. The conventional/standard electrode placementmay be presented in the form of an illustration of the patient showingpositions for one or more electrodes based on the comparison with thedatabase 1074.

FIGS. 7A and 7B illustrate a procedure for guiding placement of a subsetof ECG electrodes to make a conventional 12-lead ECG recording. FIG. 7Ashows a picture 700 of a patient's chest (torso) 702 to which the ECGelectrodes will be applied. This picture may be taken immediately beforeit is desired to apply (immediately before applying) the electrodes. Thesubject may be instructed to position themselves (or they may bepositioned by a user) in a particular posture; for example, the subjectmay be asked to stand, sit, lie down, etc. The patient's posture may bematched to the posture of the body types in the electrode placementdatabase.

In FIG. 7A, the picture is taken with the patient's shirt removed. Thepatient is standing, and their arms are down at their sides. Anormalization marker 704 is included on the patient as well. Thenormalization marker may be any marker having properties that are known(or entered into) the system or device. In FIG. 7A the marker is acircular sticker that is placed on the upper right side of the patient'schest before taking the picture. The sticker has an approximatelyone-inch diameter. In some variations the maker is a common object ofknown dimensions that is placed or held by the subject while taking thepicture. For example, a coin (e.g., quarter, nickel, penny, etc.) may beplaced on the patient. As described in more detail below, thenormalization maker may provide a reference to normalize the figures sothat it can be directly compared with the electrode placement database.

The patient picture in FIG. 7A can then be compared to the electrodeplacement database to find a match with one or more of the body types inthe database. In some variations, if no close match is found, anotification that the system/device cannot find a match or cannotprovide positioning, may be provided. In any variation, the method andsystem may provide an indication of the confidence of thematch/placement guidance, which may be based on how closely the patientpicture matches body types in the database.

Once one or more matches is identified from the database, thepredetermined conventional and/or standard electrode positioning for theone or more close matches may be used to suggest positioning ofelectrodes for the patient. For example, electrode placement positionsmay be extrapolated from the matching body type(s) and shown on thepicture of the patient, as illustrated in FIG. 7B. In this example, sixECG electrode positions 726 are shown on the patient's picture. Thisimage may be presented to the user to assist them in placing theelectrodes on the subject. After placement, the patient's picture may betaken to confirm that the electrodes have been properly positioned, asillustrated in FIGS. 8A and 8B.

In general, electrode placement may be confirmed using the methods andsystems described herein. FIG. 8A shows a picture 800 of a patient'storso 802 (similar to FIG. 7A), in which six electrodes (numbered one tosix) have been positioned 816. This picture (which also includes marker804) can be compared to an electrode placement database to generate animage 820 of the patient (including the actual electrode positions) ontowhich proposed electrode positions 826, 826′ are also shown. In FIG. 8B,the conventional/standard electrode positions are overlaid onto thepicture 800. Thus, the user may move or adjust the position of theelectrodes as shown in the image 820. Although the technique illustratedabove provides images of the patient showing correspondingconventional/standard electrode positions based on the database, in somevariations the image of the patient showing the conventional/standardelectrode positions determined from the database may be displayed on avideo (including real-time display) of the patient, allowing real-timerepositioning of the electrodes.

For example, in FIG. 8B the suggested positions for the six ECGelectrodes 826, 826′ are slightly shifted from the positions of theactual electrodes 816 already on the patient's chest. In somevariations, the suggested or proposed positions may be shown in asemi-transparent visual. In general, the proposed positions may be shownin a color. The outputted image may be enlarged by the user to help showthe relative position of the proposed conventional/standard electrodepositions. Although the majority of examples provided herein include anoutput image in which conventional/standard electrode positions areillustrated on a picture of the subject, in some variations, the outputis an image of the closest match from the database, showing thecorrectly placed conventional/standard electrode positions on a bodythat is most closely similar to that of the patient.

The picture of the patient can be provided from any appropriate source.In some variations the picture is taken using a computer device with acamera or adapted for use with a camera, including the built-in camera.Examples of computer devices with cameras include smartphones, cellphones, laptop computers, tablet computers, digital cameras, and homecomputers adapted for use with a camera. The control logic controllingthe handheld computing device may directly access the camera to take thepicture, or it may access stored pictures, e.g., stored in a memory onthe handheld computer, and allow the user to select the picture to beused. As mentioned, the system may guide the user to take and/or selectthe picture to use, including taking the picture with the normalization(e.g., sizing) marker visible. In general, the picture of the patientcan be taken by a user or the patient. Examples of users include medicaltechnicians, nurses, and doctors.

For example, the picture of the patient can be previously taken, e.g.stored on the computer device, and selected for comparison. The pictureof the patient can be taken within an application and then selected forcomparison. The picture of the patient can be previously taken andstored on a remote server and selected from a remote server forcomparison.

The picture of the patient generally includes the region of the patientwhere the electrodes will be applied. For example when the method,devices or systems are for guiding a user to place or correct placementof ECG electrodes, the picture can include the chest of the patient. Thepicture of the patient can include electrodes already placed on thechest. The picture may therefore be taken or selected so that it showsthe patient's bare (or relatively bare) chest. In some cases thepatient's chest can be covered by clothing.

As mentioned above, the picture of the patient can include a normalizingmarker. The marker (e.g., sizing marker) may have a known size. Themarker can be used to normalize or standardize the picture of thepatient prior to comparison with the database. For example, the markermay allow the picture to be normalized by scaling the picture based onthe known size of the marker so that it approximates the size of thebody types in the database. Other features may be normalized as well,including the brightness, contrast, focus, etc. of the picture using theknown properties of the normalizing marker. A picture of a patienthaving a normalizing marker can be analyzed to normalize the sizing ofthe picture of the patient to size compare with the representations inthe database. Thus, normalization or standardization of the picture ofthe patient can facilitate the comparison of the picture of the patientwith the database containing information on predetermined electrodeplacement positions for a plurality of different body types.

The picture (an in some variations the normalized picture) of thepatient is generally compared to an electrode placement database todetermine one or more close matches between the patient picture and theexemplary or body types in the database, for whom conventional orstandard electrode placement positions are known relative to eachexemplary body type. Thus, an electrode placement database may includeinformation on predetermined electrode placement positions for aplurality of different body types. The database can includerepresentations for electrode placement for a plurality of differentbody types. In some variations, the representations of body typescomprise images bodies including electrodes positioning in apredetermined, conventional and/or standard position for a particularelectrode placement regime. In some variations the representations ofbody types includes information extracted from an image, such asanatomical landmarks for each different body type. Thus, therepresentations of different body types may include characteristicproperties of each body type in the database (size, shape, etc.), withcorresponding electrode placement information for that body. Forexample, distance and direction between the predetermined locations forthe electrode placement and anatomical landmarks may form at least partof the database. The representations may be normalized each of thedifferent patients included in the database. For example, an electrodeplacement database may include images of a variety of bodies with theelectrodes shown on the body (a corresponding image without theelectrodes present may also be included). The database can include avariety of different exemplary bodies, spanning a variety of differentbody types, weights, heights, genders, sizes, ages, body mass indexes,etc.

In some embodiments the database is stored on a remote server. In someembodiments the database can be stored on system or device (e.g., ahandheld computer device) locally.

As mentioned above, the electrode placement database typically includesrepresentations of a plurality of different body types that can becompared against a patient picture (or against descriptive informationextracted from the patient picture), and each body type has acorresponding predetermined, conventional and/or standard electrode(s)position for that body type. As used herein, a body type refers to anexemplary body, which may include characteristic shape, size, gender,position, etc. The corresponding predetermined, conventional and/orstandard electrode(s) position may be verified for that body type by anexpert trained in positioning the electrode(s) for the electrodeplacement regime of the database. For example, an electrode placementdatabase for placing ECG electrodes in a conventional 12-lead ECGpattern may include a number of images of “model” body types each ofwhich has a verified arrangement of electrodes in the predetermined,conventional and/or standard electrode(s) position for a 12-lead ECG.Thus, these model body types may correspond to images of subjects havingconventionally placed 12-lead ECG electrodes. The placement for eachmodel body type may be confirmed by an expert in placing electrodes infor 12-lead ECG measurement.

A database may include any number of model body types. For example, insome variations the database includes more than 100 model body types;more than 500 model body types; more than 1000 model body types; morethan 2000 model body types; more than 5000 model body types, etc. Thesame subject may provide more than one model body type in the database,since different body positions (e.g., sitting, standing, lying down,etc.) or different angles (oblique, face-on, etc.) may be taken from thesame individual, allowing the system to match a patient in a variety ofpositions and/or angles. Each model body type in the database may alsobe normalized (e.g., scaled) so that they can be compared more reliablyagainst each other and against patient pictures.

FIG. 9 shows an example of model body types with corresponding ECGelectrodes, illustrating a variety of body morphologies that are part ofthe electrode placement database 805. For illustrative simplicity, onlythree examples are shown, though more may be included, as mentionedabove. The database may also include male and female bodies, and avariety of different ages, ethnicities, sizes, etc.

In FIG. 9 the electrode placement database includes image of differentbody types with predetermined, conventional or standard electrodepositions included in the image. In some variations the database mayalso or alternatively include body type characteristic informationextracted from different body types, including different morphologies.For example, the database may include anatomical landmarkcharacteristics (measurements). This information may be extracted fromimages such as those shown in FIG. 9. When comparing the patient pictureto the database, the patient picture may have the same anatomicallandmarks extracted for direct comparison with the database.

For example, in some embodiments, comparing the picture of the patientto the database can include comparing anatomical landmarks on thepicture of the patient to anatomical landmarks in the database. Asmentioned, anatomical landmarks can include the torso size, length, andconfiguration of a body region (e.g., torso). Anatomical landmarks mayinclude the shoulder width and configuration, for example the size andshape of the clavicle. The anatomical landmarks can include the size andconfiguration of the arms and legs. The anatomical landmarks can includethe chest size and width including the sternum, sternal notch, and ribconfiguration. The anatomical landmarks can include the size andconfiguration of the chest and ribs including the first, second, third,fourth, and fifth intercostal spaces, and the manubriosternal junctionalso referred to as the Angle of Louis, as much as they are detectablefrom the external anatomy apparent in the picture of the patient. Theanatomical landmarks can include areas on the arms, legs, chest, neck,etc. Anatomical landmarks may also include the distances between variousbody regions. In some embodiments the fourth intercostal space can bedetermining from the manubriosternal junction. The fifth intercostalspace, mid-clavicular line, left anterior axillary line, and leftmid-axillary line can also be determined from the picture of thepatient. In some embodiments the electrode placement can be determinedbased on the location of the fourth intercostal space, fifth intercostalspace, mid-clavicular line, left anterior axillary line, and leftmid-axillary line.

FIG. 11 illustrates a method of guiding placement of electrodes on apatient. A system or device for guiding placement of electrode may beconfigured to perform all or some of these steps. For example, in somevariations the user may be instructed to take or upload a picture of thepatient 1101, and particularly the region of the body where theelectrodes will be positioned. The device or system may include writteninstructions, spoken instructions and/or visual instructions to guidethe user through the steps of taking or selecting a picture of thesubject. For example, a handheld computer device (e.g., smartphone) mayinstruct the user to place a normalization (e.g., sizing) marker on thepatient 1103, position the patient (e.g., lying down) and take afront-on picture of the patient's torso, including the marker 1105. Insome variations the system or device may then ask the user to select thepicture from the library of pictures, so that the picture is received bythe system/device 1107.

The system or device may then pre-process the picture of the patient.Preprocessing may include normalizing the picture 1109. For example, ifa normalizing marker is use, the picture may be scaled using thenormalizing marker. Since the size of the normalizing marker is known,the system/device may analyze the picture to identify the normalizingmarker, measure the length, and adjust the size of the picture usingthis measured length. The picture may also be cropped to remove anynon-essential regions, and the picture may be adjusted to aid incomparing the picture to the electrode placement database. For example,the picture may be contrast enhanced. In some variations pre-processingmay include extracting features (including anatomical landmarks, asdiscussed above.

The picture (or characteristic features extracted from the picture) maythen be compared to the electrode placement database 1111 to determineone or more close matches with the body types in the database 1113. Forexample, the picture may be matched against the body types in thedatabase to find the most similar body type or types. The predetermined,conventional/standard electrode placement from the one or more closestmatches may then be used to determine electrode placement for thepatient 1115. If there is a single close match, the electrodepositioning for the closest match may be applied to the patient. Forexample, in variations in which the database includes images of the bodytypes with predetermined conventional/standard electrode placement, thematching body type image may be aligned with and overlaid onto thepatient image; in some variations all of the body type image except forthe electrode positions may be removed, so that the placement of theelectrode is shown in an image including the picture of the patient (insome variations, the normalized version of the picture). This picturemay then be output (e.g., on a display screen on the handheld computingdevice).

In some variations multiple close matches from the database may beidentified and used to determine conventional/standard electrodepositions for the patient. For example, a weighted combination of theelectrode positions (e.g., weighted by the similarity to the patientpicture) may be used to determine the electrode positions on the patientpicture.

In some variations comparing the patient picture to the database may beperformed by a neural network that is trained in matching patientpictures to the database images. Thus, the network may determine whichimages are most closely matching. Similarly or alternatively, patternrecognition may be applied to match the picture of the patient (orextracted information from the picture) to the database (includingextracted information) of body types.

As mentioned above, in some variations the system displays an image ofthe patient (e.g., taken from the picture of the patient) showing theconventional/standard positioning of the one or more electrodes on thepatient 1121. Alternatively or in addition, the system may store orupload the image 1119 after preparing it 1117.

In some embodiments comparing the picture of the body to the databasecan be done on a remote server. In some embodiments comparing can bedone on the computer device.

A system performing all or some of these steps typically includescontrol logic for controlling a processor and other system components toperform all or some of these steps. For example, in some embodiments themethods disclosed herein are performed by a computer program orsoftware/hardware/firmware (or combinations thereof). The system mayinclude software configured as an application for a smartphone or tabletcomputer that may control the operation of the system. Thus, all or someof the steps disclosed herein can be performed by the application on thesmartphone or tablet computer. The smartphone application can include auser interface. For example, the smartphone application can receive apicture of the patient and present an image of the patient showingpositioning of the electrodes.

A system or device for guiding electrode placement may therefore includecontrol logic controlling the receipt of the patient picture (and insome variations, guiding the user in taking the picture), and forpresenting the image including the patient showing marked locations forelectrodes. The control logic may direct the picture of the patient topreprocessing and/or database comparison modules either on-board thesystem/device (e.g., using the smart phone processor) or remotely (e.g.,sending the picture to a remote processor).

FIG. 13 illustrates one example of a system for guiding electrodeplacement. In this example, the system includes control logic 1309 thatis configured to run on a processor of a handheld computing device suchas a smartphone 1300. The control logic may be downloadable (e.g., anapplication software). The control logic may guide the user through theprocess as mentioned above, including taking and/or selecting thepicture of the user. The control logic may include a preprocessingmodule 1315 for normalizing and/or extracting features from the pictureof the patient. The control logic may also include a comparison module1317 for comparing the picture to an electrode placement database 1313.The database and these modules may be included as part of the controllogic, or they may be separate from the control logic, but the controllogic may control their operation, and may regulate the flow ofinformation between them. In some variations one or more of the database1313, preprocessing module 1315 and comparison module 1317 are externalto the smartphone 1300, and may be part of an external database (notshown). The control logic may control the interaction with this externaldatabase (using, e.g., the smartphone network connectivity). The controllogic may also regulate the operation of a camera 1305 that may be usedto take the patient picture, and/or a speaker, display, and any otheroutput for communicating with the user, and for displaying the generatedimage of the patient with the electrodes positions indicated. Asmentioned, a mobile computing device may typically include a processor,display, and memory; the control logic may access these components inorder to perform the functions described above.

Any of these systems may also include a normalization marker that may beused as indicated above.

In some embodiments a handheld computer device is used with the systemsand methods disclosed herein. The handheld computer device can include amobile telecommunications device, tablet computer (e.g. iPad™), orlaptop computer. The mobile telecommunications device, tablet computer,or laptop computer can include a camera or be adapted to send/receivedata with a camera. The mobile telecommunications device can include acell phone or smartphone with a camera, such as an iPhone™, Android™, orother smartphone. In some embodiments a hand held camera can be used.The hand held camera can have network connectivity such that it can sendand receive data over a wireless network (WiFi) or cellular network (3G,4G, etc.).

In some embodiments the methods disclosed herein can be performed inwhole or in part by firmware. In some embodiments the methods disclosedherein can be performed by a combination of firmware and software.

Images showing electrode placement can be presented to the patient oruser. The images can be presented on a computer device. For example, theimages can be presented on a smartphone, cell phone, laptop computer,tablet computer, digital camera, or home computer.

As mentioned above, in some embodiments comparing the picture of thepatient with electrodes includes verifying the placement of theelectrodes on the patient or providing further instructions to thepatient to correct the electrode placement. The further instructions caninclude an image of the picture of the user showing the correctelectrode placement or annotations to show the correction of theelectrode placement. The further instructions can also include text orother instructions to correct the electrode placement, such asinstructions to move a specific electrode by a determined amount or to aspecific location.

In some embodiments the electrode configurations can correspond to thestandard or conventional 10 electrode placement used for a 12-lead ECGwith the arm and leg electrodes placed near the wrist and ankle. In somecases the electrodes on the presented image can be color coded tocorrespond with the colors used in the conventional 12-leadconfiguration.

In some embodiments the electrode configurations can correspond to3-lead or 5-lead configurations. In some embodiments the electrodeconfigurations can correspond to the Mason-Likar configuration or othernon-conventional electrode configuration. In some embodiments theelectrode configurations can be used to show the placement of V₁-V₆only.

Conventional electrode placement for the 12-lead ECG places theelectrodes on the left side of the body. In some cases it may bedesirable to place the electrodes on the right side of the body. In someembodiments the electrode configuration can be on the right side of thebody.

In some embodiments a second picture can be taken after the electrodesare placed on the patient using the image of the patient showing theelectrode placement. A picture of the body of the patient with theelectrodes placed on the patient can be taken. The picture of the bodycan be compared to the database to verify the placement of theelectrodes. If the electrodes are in the predetermined location then theelectrode placement is confirmed. If one or more electrodes are not inthe predetermined positions then instructions to correct the electrodescan be determined. The instructions can include a modified image of thepicture of the patient's body showing the correct electrode placement oran annotated picture of the body showing the electrodes that need to bemoved.

After the electrodes are placed on the body of the patient theelectrodes can be used to take an ECG. In some embodiments the ECG canbe taken in a medical office, hospital, or ambulance. In someembodiments the ECG can be taken outside of a medical office, such as atthe home of the patient.

In some embodiments, the electrodes can be attached to the computerdevice to take the ECG after the electrodes are placed on the patient.In some embodiments the electrodes can be attached to a device that cancommunicate with a smartphone or tablet computer. The smartphone ortablet computer can then be used to record electrical signals from theelectrodes to take an ECG. The computer device can provide instructionsfor taking the ECG. The electrical signals can be analyzed to scan forerrors such as switched electrodes or other problems discernible fromthe electrical signals. The ECG data can be recorded over a period oftime and averaged to prepare an ECG for a representative heartbeat.

Additional examples of methods, systems and devices for guidingplacement of electrodes according to a predetermined, conventionaland/or standard electrode placement regime are briefly discussed below,in addition to the examples already provided above.

EXAMPLE 1

FIG. 12 is a flowchart of one exemplary method 90 for determining theplacement of electrodes on a patient. A picture of a patient including asizing marker is received 92. The picture of the patient is normalizedusing the sizing marker to produce a normalized picture of the patient94. The normalized picture of the patient is compared to a databasecomprising representations of a plurality of body types andpredetermined electrode placement positions for each body type todetermine positioning of electrodes on the patient 96. An image of thepatient is then presented showing positioning of electrodes on the imageof the patient 98.

The image can be presented on a handheld computer device such as asmartphone or tablet computer. The user or patient can place theelectrodes based on the presented image. The electrodes can then be usedto take an ECG.

EXAMPLE 2

A smartphone can be used by an emergency medical technician (EMT) totake a picture of the chest of a patient. The picture of the patient canbe selected by the EMT for use with the smartphone application. Thesmartphone application can then present an image of the patient showingthe electrode placement on the image of the patient to the EMT. The EMTcan then place electrodes on the body of the patient using the image ofthe patient showing the electrode placement. After placement of theelectrodes the patient is ready to have an ECG taken. The ECG can betaken by the EMT or taken later.

EXAMPLE 3

A smartphone or tablet computer can be used by a doctor or nurse in amedical office to take a picture of the patient. The picture of thepatient can be selected by the doctor or nurse for use with thesmartphone or tablet computer application. The smartphone or tabletcomputer application can then present an image of the patient showingthe electrode placement on the image of the patient to the doctor ornurse. The doctor or nurse can place electrodes on the body of thepatient using the image of the patient showing the electrode placement.After placement of the electrodes the patient is ready to have an ECGtaken.

EXAMPLE 4

A user can take a picture of their body using a smartphone while athome. The user can select their picture for use with a smartphoneapplication. The smartphone or tablet computer application can thenpresent an image of the user showing the electrode placement on theimage. The user can place electrodes on their body using the imageshowing the electrode placement. After placement of the electrodes theuser is ready to have an ECG taken.

EXAMPLE 5

A user or patient can use the front-facing camera and display of thesmartphone for guidance with placing electrodes in real time. Thesmartphone display can show the picture of the patient's body taken bythe front-facing camera in real time along with the predeterminedelectrode placement overlaid on the real time picture of the patient'sbody.

EXAMPLE 6

A database containing information on electrode placement for variousbody types can be prepared. Methods for preparing the database caninclude taking a picture of the body of a test subject having electrodesplaced on the body, analyzing the pictures of the bodies of the testsubjects, categorizing the electrode placement data based on theanatomical landmarks on the test subjects, and generating a databasecontaining electrode placement data based on body type and anatomicallandmarks.

The database can be prepared by analyzing pictures of patients havingelectrodes correctly placed on their body. The electrode placement canbe analyzed and quantified in relation to anatomical landmarks on thebodies of the patients.

The data for each patient can be classified based on any of the datacollected. For example, the data can be classified based on body type,weight, height, gender, size, age, body mass index, etc. The datacollected for the database can include the distance and directionbetween the areas for the desired electrode placement and anatomicallandmarks.

The methods for generating the database can include taking pictures ofeach patient with and without the electrodes placed on the body.

From the above descriptions, it is clear that the presently disclosedand claimed inventive concept(s) are well-adapted to carry out theobjects and to attain the advantages mentioned herein. While thepresented embodiments have been described for purposes of thisdisclosure, it will be understood that numerous changes may be madewhich will readily suggest themselves to those skilled in the art andwhich are accomplished within the spirit of the presently disclosed andclaimed inventive concepts.

1.-.24 (canceled)
 25. A computer-implemented system comprising: a. adigital processing device comprising an operating system configured toperform executable instructions and a memory; b. a computer programincluding instructions executable by the digital processing device tocreate an electronic image database comprising: i. a software moduleconfigured to store a plurality of images each representing a differentbody morphology, said plurality of images each also having arepresentation of a position of at least one ECG electrode relative tothe different body morphology represented in each of the plurality ofimages; ii. a software module configured to determine, using one or moreof the plurality of images, whether proper electrode placement isachieved by a user.
 26. The system of claim 25, wherein proper electrodeplacement is achieved when an image of the user is determined to matchone or more of the plurality of images.
 27. The system of claim 26,wherein the image of the user includes a representation of at least oneECG electrode relative to a body of the user.
 28. The system of claim25, wherein the digital processing device comprises a smartphone. 29.The system of claim 28, wherein the computer program further comprises asoftware module configured to generate an image representing properelectrode placement relative to a body of the user.
 30. The system ofclaim 29, wherein the smartphone is configured to display the imagerepresenting proper electrode placement.
 31. The system of claim 25,wherein the digital processing device comprises a smartwatch.
 32. Thesystem of claim 31, wherein the computer program further comprises asoftware module configured to generate an image representing properelectrode placement relative to a body of the user.
 33. The system ofclaim 32, wherein the smartphone is configured to display the imagerepresenting proper electrode placement.
 34. The system of claim 25,wherein to determine, using one or more of the plurality of images,whether proper electrode placement is achieved in a user comprisescomparing the one or more of the plurality of images to an image of theuser.
 35. The system of claim 34, wherein the computer program furthercomprises a software module configured to select one or more of theplurality of images that most closely matches the image of the user. 36.The system of claim 35, wherein the one or more of the plurality ofimages that most closely matches the image of the user matches in termsof a body shape of the user.
 37. The system of claim 35, wherein the oneor more of the plurality of images that most closely matches the imageof the user matches in terms of a body size of the user.
 38. The systemof claim 35, wherein the one or more of the plurality of images thatmost closely matches the image of the user matches in terms of a bodyposition of the user.
 39. The system of claim 34, wherein the one ormore of the plurality of images is compared to the image of the userusing a feature extraction technique.
 40. The system of claim 34,wherein the image of the user includes a normalization marker.
 41. Thesystem of claim 40, wherein the normalization marker is used to comparean image of the user to the one or more of the plurality of images.